Downtown Eastside health team tackles high rates of lung disease

A new health initiative in Vancouver’s Downtown Eastside is going to residents in their own buildings to test them for undiagnosed lung illness, a condition that is widespread among the area’s impoverished and addiction-prone residents.

“I’m here to find out if I have lung disease,” said George Dupont, as he met on a Friday in mid-October with the clinical tenant support team that was testing residents in a special room set aside for health care at his hotel.

He came down to the room after a nurse knocked on residents’ doors at the Hazelwood Hotel on East Hastings Street inviting them to blow into a special machine called a spirometer.

After Dupont had blown into the machine three times, he was given a drug to see if this would improve his breathing. Then he blew into it three more times. After his 30-minute test finished, he was told he’d get a follow-up visit to talk about his results.

Many residents, like Dupont, are at high risk for lung disease. They live in single-room-occupancy hotels and are considered vulnerable because many of them are smokers but do not have regular access to health care due to addiction and mental health problems.

A 2005 study found that only one in five adult smokers in the Downtown Eastside with objective lung disease had been diagnosed.

Risky circumstances

People in this neighbourhood are heavy smokers of all kinds of substances, including tobacco, cannabis and crack cocaine.

As a result, there is increased risk of lung ailments like chronic obstructive pulmonary disease, which is a major cause of death in the Downtown Eastside.

Team members are hoping the hotel testing will make a difference.

“A huge accomplishment would be getting one of my clients screened for spirometry and seeing if he has lung disease, because I suspect he might, and then actually being able to treat him,” said Elizabeth Leonardis, a nurse practitioner who works with the tenant-support team for Vancouver Coastal Health.

Helping people breathe better

Inhalers are often prescribed for people who have symptoms like chronic cough, mucus over-production, wheezing and shortness of breath. However, treatment can only be effective with proper testing and diagnosis.

“Early identification could definitely improve care in the long term,” said Leonardis, pointing out that certain treatments keep people out of hospital and save money. Additionally, flare-ups can be better managed, especially in the fall when respiratory illnesses increase.

The team is bringing breathing tests to Downtown Eastside residents they already know through other programs.

“We will be targeting our primary-care clients predominately who we’re well engaged with and have good relationships with,” said Leonardis.

The goal was to test a few people on three Fridays in October. As the first day of testing ran from 1 p.m. to 3 p.m. at the Hazelwood, seven other residents besides Dupont came through the door.

Chaotic lifestyles

Testing is only half the battle. There are further challenges since some people do not use their inhalers.

“The main reasons for this are lack of education and understanding around their use,” said Leonardis.

It is often very difficult for people to remember to use their medication and keep track of it, given the chaotic nature of residents’ lives in the hotels.

“So much of what I do for people is in the moment,” said Leonardis. “I do my best to get there because, if I don’t, I’ve probably missed my window.”

Leonardis says it’s important to try to make contact with residents when it works for them.

“When people are engaged, you have to capitalize on that engagement so we do our best to go with their schedule instead of our own,” she said.

After his test, Dupont walked out with a five-dollar coffee card and a chocolate bar as a thank-you for his participation.